1. Health Care Reform A Review of Some International Activities Prof.Dr. Evert Reerink World Bank Washington

2. Reform in Health Care Discuss some international experiences in health care reform Introduce programme evaluation as a method to assess achievements and improve where necessary

3. What is Health Care Reform? Overall goal of the activity: To improve health care Often there are important subgoals: Changes in healthcare financing Changes in equity, access Changes in availability of resources Deregulation, decentralisation

4. Why Health Care Reform? Political motives Scientific motives Financial motives Societal motives Whatever motive, there is always the need for proper evaluation to determine its success

5. Health Care Reform Most prevalent forms: decentralisation separation of payer and provider Autonomy for hospitals (ownership) new roles for consumers and citizens

6. Why Programme Evaluation? Provides answers to questions re: programme effectiveness and efficiency Serves as a tool to find out about programme quality Can be used as a tool to improve quality of services and performance Can be used as a revitalisation tool

7. Why Quality Assurance? Interesting to know Required as an element of reform We want to improve We want to redesign It’s only natural (QA is part of health care)

8. Evaluating Impact of Reform Evaluation follows major goals: Mortality and Morbidity Provider satisfaction Client satisfaction Cost/expenditures development Intersectoral relations (referrals) Etc.

9. Health Care Information: Indicators Conformity with “Good Practice” Impact on community (satisfaction) National, regional and Local Tracers Regional and Local Growth (GNP) Referral rates Effectiveness indicators (health) Efficiency indicators (utilisation)

10. Health Care Information: More Indicators Accessibility Portability (endurability) Public administration Universality: coverage for all Comprehensiveness Equity: equal opportunity for use relative to need.

11. Outcomes Increased health for target population Community orientation Reputation (safety; transfers; brain drain) Referrals; length of stay; occupation rates Satisfaction (providers; clients) Costs and expenditures Contributions to other programmes (e.g. workers compensation)

12. Barriers to Healthcare Utilisation Study subjects: Geographical access perceived low quality lack of pertinent information Irrelevant client expectations inability of clients to pay full cost Focus on vulnerable groups !

13. Modern Health Care Needs Integrated quality assurance Information Technology Stable Financing Ownership Focus on Core Business Standards based on Evidence Innovative environment for rejuvenation Licensing/Accreditation System

14. Future Health Care Needs Integration of independent elements (through financing adaptations) Disaster Planning (through scenarios) Human Resources Planning (scenarios) Decentralisation / Devolution (policies) Privatisation (policies) Increased flexibility (behavioural change)